Welcome back to our look at Medifund. Today we shall take a look at who qualifies for Medifund.

Over two decades on, the Ministry of Health has never publicly revealed the full details of Medifund eligibility such as income threshold and housing type. It has said that only Singaporeans are eligible and applications are made through the public hospitals' social work department.

At quick look at the Ministry of Health's website lists the following as it's assessment criteria for eligibility for Medifund aid:

1. Be a Singapore citizen

2. Is a subsidized patient

3. Have received treatment from a Medifund-approved institution

4. Patient and family have difficulties affording the medical bill despite heavy government subsidies, MediShield and Medisave.

Patients who fulfill these criteria may approach the Medical Social Workers (MSWs) of the Medifund-approved institution to apply for Medifund assistance. Ministry of Health Website

In 2002, Mr. Gan Kim Yong (before he assumed the role of Health Minister) noted in parliament that "Medifund has been used to help subsidize the lower income group... Indeed, that is a good sign," he went on to ask if the Ministry of Health would "consider increasing the amount available for [Medifund] and relaxing the criteria so that more can benefit from it." Gan Kim Yong, Singapore Parliament Reports, Hansard. Public Sector Hospitals (Fee increases) 1 Oct 2002.

Then Minister of State for Health, Dr. Balaji Sadasivran, replied to Mr. Gan by saying: "More than 99.7% of the applications have been approved even though the number of applications has gone up from 55,000 to 157,000+. So we are assisting many more people today then we were six years ago." Balaji Sadasivran, Singapore Parliament Reports, Hansard. Public Sector Hospitals (Fee increases) 1 Oct 2002.

The government's reluctance to fully reveal the details about Medifund eligibility are probably for the following two reasons:

1. The prevention of abuse and "gaming" of the system. Which goes back to the moral hazard argument highlighted during the Medisave discussion of this series.

2. Some opacity allows the government full discretion in dictating and adjusting the eligibility criteria to ensure appropriately high rates of successful applications and a positive political positioning.

Application for Medifund support can only be made through a Medical Social Worker in an accredited-Medifund facility (usually a public hospital) and not directly by the patients themselves or their families. This makes criticism that the government is not doing enough appear to be simple generalizations especially if critics are unaware of the full picture behind a patient's circumstances. This mechanic only allows people in the know (especially the Medical Social workers) to interpret the significance of the rate of successful application and the quantum of pay outs made.

Structuring Medifund as an endowment assures that with principal protection, the fund in theory will never be depleted. Also because the investment income from the previous year is utilized with hospitals distributing funds from a pool that is fixed on an annual basis, the government will never end up over committing to "free medical service to Singaporeans who are poor and indigent."

The question: "Can Medifund ever run out of money in any given year?" was raised in parliament in 1993. Then Health Minister Mr. Yeo Cheow Tong said in his reply: " As regards hospitals lacking funds, some funds will always be available. But as in everything, the funds are finite. The hospitals must ensure that they utilize the funds in the right way. And if they do that, I think the funds will be adequate. This means that they must stick to the criteria and not deviate from them." (Yeo Cheow Tong, Singapore Parliament Reports, Hansard. Medical Endowment Scheme Bill, 18 Jan 1993)

Come back next time where we discuss what we don't know about Medifund.